Remote Temporary Prior Authorizations Nurse (RN)

Summary

Join Central California Alliance for Health (the Alliance) as a Prior Authorization Nurse RN in a temporary position. Ensure prior authorization requests are completed timely to meet contractual requirements and conduct reviews using nationally recognized standards.

Requirements

• Knowledge of: Current working knowledge of Milliman Care Guidelines in review determination process
• Medi-Cal and related policy and Title 22 regulations
• Utilization management principles and activities
• Case management principles and activities
• Ability to: understand concepts pertaining to prepaid health care
• Demonstrate strong critical thinking and clinical nursing skills
• Use MS Word
• Evaluate medical records and other health care data
• Bachelor’s degree in Nursing and a minimum of three years of experience in a patient care setting which included a minimum of one year of experience in Utilization Management or Case Management; or an equivalent combination of education and experience may be qualifying
• Current unrestricted license as a Registered Nurse issued by the State of California

Responsibilities

• Ensure that prior authorization requests are completed in a timely fashion to meet contractual requirements
• That all reviews are conducted using nationally recognized and evidence-based standards